BT Technology Journal

, Volume 24, Issue 3, pp 17–32 | Cite as

Towards an interoperable healthcare information infrastructure — working from the bottom up

  • D. Ingram
  • D. Kalra
  • T. Austin
  • M. W. Darlison
  • B. Modell
  • D. Patterson


Historically, the healthcare system has not made effective use of information technology. On the face of things, it would seem to provide a natural and richly varied domain in which to target benefit from IT solutions. But history shows that it is one of the most difficult domains in which to bring them to fruition. This paper provides an overview of the changing context and information requirements of healthcare that help to explain these characteristics.

First and foremost, the disciplines and professions that healthcare encompasses have immense complexity and diversity to deal with, in structuring knowledge about what medicine and healthcare are, how they function, and what differentiates good practice and good performance. The need to maintain macro-economic stability of the health service, faced with this and many other uncertainties, means that management bottom lines predominate over choices and decisions that have to be made within everyday individual patient services. Individual practice and care, the bedrock of healthcare, is, for this and other reasons, more and more subject to professional and managerial control and regulation.

One characteristic of organisations shown to be good at making effective use of IT is their capacity to devolve decisions within the organisation to where they can be best made, for the purpose of meeting their customers’ needs. IT should, in this context, contribute as an enabler and not as an enforcer of good information services. The information infrastructure must work effectively, both top down and bottom up, to accommodate these countervailing pressures. This issue is explored in the context of infrastructure to support electronic health records.

Because of the diverse and changing requirements of the huge healthcare sector, and the need to sustain health records over many decades, standardised systems must concentrate on doing the easier things well and as simply as possible, while accommodating immense diversity of requirements and practice. The manner in which the healthcare information infrastructure can be formulated and implemented to meet useful practical goals is explored, in the context of two case studies of research in CHIME at UCL and their user communities.

Healthcare has severe problems both as a provider of information and as a purchaser of information systems. This has an impact on both its customer and its supplier relationships. Healthcare needs to become a better purchaser, more aware and realistic about what technology can and cannot do and where research is needed. Industry needs a greater awareness of the complexity of the healthcare domain, and the subtle ways in which information is part of the basic contract between healthcare professionals and patients, and the trust and understanding that must exist between them. It is an ideal domain for deeper collaboration between academic institutions and industry.


Electronic Health Record Information Infrastructure Haemoglobin Disorder Electronic Healthcare Record Framework Programme Project 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Zimmerli W C: ’Who has the right to know the genetic constitution of a particular person’, in Human Genetic Information: Science, Law and Ethics, Ciba Foundation, London, UK, pp 93–110 (1990).Google Scholar
  2. 2.
    Johnson S P and Friedman R A: ’Bridging the gap between biological and clinical informatics in a graduate training programme’, Journal of Biomedical Informatics (in Press) (2006).Google Scholar
  3. 3.
    ’The Computer-Based Patient Record — an Essential Technology for Healthcare’, Computer-based Patient Record, Institute of Medicine (1991).Google Scholar
  4. 4.
    Blendon R J, Schoen C, DesRoches C, Osborn R and Zapert K: ’Common Concerns Amid Diverse Systems: Health Care Experiences In Five Countries’, Health Affairs, 22, No 3, pp 106–121 (2003).CrossRefGoogle Scholar
  5. 5.
    Rittel H J and Webber M M: ’Planning problems are wicked problems’, in Cross N (Ed): ’Developments in Design Methodology’, Wiley, pp 135–144 (1984).Google Scholar
  6. 6.
    ’For Your Information — A Study of Information Management and Systems in Acute Hospitals’, The Audit Commission, HMSO Publications, London, UK (1995).Google Scholar
  7. 7.
    Rosleff F: ’European Healthcare Trends: Towards Managed Care in Europe’, Coopers & Lybrand, London (1995).Google Scholar
  8. 8.
    Kennedy I: ’Learning from Bristol: the report of the public inquiry into children’s heart surgery at the Bristol Royal Infirmary 1984 — 1995’, Command Paper: CM 5207, The Stationery Office Limited (July 2001) —
  9. 9.
    Walker J, Pan E, Johnston D, Adler-Milstein J, Bates D W and Middleton B: ’The Value of Healthcare Information Exchange and Interoperability’, Health Affairs, Web Exclusive (January 2005).Google Scholar
  10. 10.
    ’eHealth — making health care better for European citizens’, Commission of the European Communities, SEC(2004)539 (April 2004) —
  11. 11.
    ’Computer Technology in Medical Education and Assessment’, Background Report, Office of Technology Assessment, Congress of the United States, Library of Congress, (1979).Google Scholar
  12. 12.
    Ingram D: ’The Good European Health Record’, in Laires M, Ladeira M and Christensen J (Eds): ‘Health in the New Communications Age’, IOS Press, Amsterdam, pp 66–74 (1995).Google Scholar
  13. 13.
    Grimson J, Grimson W, Berry D, Stephens G, Felton E, Kalra D, Toussaint P and Weier O W: ’A CORBA-based integration of distributed electronic healthcare records using the synapses approach’, IEEE Trans Inf Technol Biomed, 2, No 3, pp 124–38 (September 1998).CrossRefGoogle Scholar
  14. 14.
    Ingram D, Lloyd D, Beale T, Schloeffel P, Heard S and Kalra D: ’The openEHR Foundation’, —
  15. 15.
    CHIME (and also for information on GEHR Project, Synapses Project, Synex Project, CLEF Project) —
  16. 16.

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • D. Ingram
  • D. Kalra
  • T. Austin
  • M. W. Darlison
  • B. Modell
  • D. Patterson

There are no affiliations available

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